Claim total
$641.13
base $93.83 · payer covered $641.13
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2023-11-18
- Stop
- 2023-11-18
The parties
- Provider
- provider Tennille Baumbach
- Care site
- care site STONEBRIDGE WELLNESS LTD
- Payer
- payer Dual Eligible
Record id
021142be-3a32-af72-8a87-860208bc26ad